The birth story

Email me at doctordandle at gmail dot com for photos.

We visited my gynaecologist a day after my due date. She asked how I was, and I replied “still pregnant”. She decided to schedule us for an induction two days later, which was fine with us. She wrote out a prescription which looked a lot like “1 baby, 8h30, 29 July 2010”.

On Friday morning, we got everything ready. It was weird knowing that (hopefully) next time I returned to our home, it would be with a baby. It was a beautiful summer day as we took the ten minute walk through the park to the hospital. My husband tried to meander, but I was feeling very mission oriented.

Once we got there, we were asked to wait on the chairs by the entrance until a room became available. I was seated next to a young girl, her boyfriend, and her mother. Her mother couldn’t stop crying and said that her 22 year old daughter was too young to have a baby. I didn’t see them again - I hope everything is going well with them.

The midwife called me in and gave me an internal exam. I asked if I was going to be induced with oxytocin, and she said that she had to calculate a score first. I asked her if she was talking about the Bishop score, and she asked me if I worked in the field or just read a lot. I told her that I just read a lot.

It turns out I had a bad Bishop score, so they were going to induce me with oral Prostaglandin 1 tablets instead of a drip. They would monitor me for an hour, give me some tablets, monitor me for another two hours, another tablets, etc, until something happened.

They set me up in the delivery room around 10am, where we were to spend the next day and a half. There was an uncomfortable padded shelf for my husband and a bed for me. I got changed into my “I dream of sushi” delivery outfit, complete with belly hole for monitoring. The midwife said that in all her 11 years of work, she had never seen anything like it. I showed her the low back for the epidural, and she said that she hoped I got an epidural so we could make use of her. I assured her that I would certainly be getting an epidural.

For the next ten hours, it was a little like we were on a long haul flight. I couldn’t feel anything, but we could watch the irregular and small contractions on the monitor, and listen to the baby’s heartbeat. We could see the baby’s transition from wake to sleep every hour or so.

They served me meals but didn’t have anything for my husband, so he popped out for ten minutes to grab a quick dinner. While my husband was out, at 8:02pm, I felt this little pop and then this extreme gushing. It took a few moments for me to realise that my water has just broken. I send my husband a text message saying “Water just broke.” My husband rushes back and is there almost before the nurse.

The nurse comes in and I tell her the news, feeling somewhat alarmed. There is now a huge quantity of liquid gushing out of me and I’m starting to panic. I am astonished by her response - perfect, fantastic! She tells me that she was worried that she would have to send me home. Now she can finish her shift happy, knowing I will have this baby tomorrow. I ask her about the colour of the fluid, and she tells me that it is clear, that everything looks good. She is sad that I have gotten my dress dirty, but I tell her that it was sort of a single-use outfit, and I change into my spare one.

The midwife asks us for our baby clothes, and it starts to hit me that they are actually expecting a baby to arrive. We give her the outfit, and she asks us "is this all you brought?". Apparently over here, babies don't just wear a nappy and a onesie, they also wear baby underwear, which is weird. Throughout our stay all the healthcare professionals are puzzled by the lack of underwear we dress our baby in, even though it is summer and the hospital does not have air conditioning.

At around 10pm, the contractions become painful, and I ask for an epidural 10pm. The next midwife seems rushed, sad, and distracted. We sense that it has been a difficult night on the ward, with perhaps an unhappy story. She says that I am only 2cm dilated, and the minimum was 3cm. She gave me some more oral prostaglandin 1 to help with the contractions. At 11pm, I ask again, but my contractions are not regular enough.

The contractions are getting more and more painful. I remember reading that one should visualise the baby through each contraction, but for me this isn’t very useful, as I realise that I am terrified of being responsible for a baby, and thinking about this just sends me into a panic. The common mantra “labour pain is good pain” is also not very helpful. I end up sitting on a Swiss ball, and having my husband massage my back. I repeatedly tell him that I really like the bits in between contractions. As I feel each contraction begin, I feel ambivalent. As they get stronger and closer together, I become a better epidural candidate, but they still hurt a lot.

At midnight, I ask for an epidural again, and she checked me, and very kindly announced I was “3 very small centimetres”, and confirmed I wanted an epidural. “Yes”, I answered immediately, without pause or hesitation. She called the anaesthetist, who explained the procedure.

I start shaking from fear, as I sat on the edge of the bed with my back curled over. I tell myself that the pain of the procedure will be less than the contractions, but I am still really scared. They ask me to tell them when I was having contractions and they would stop their work, and luckily they weren’t so close together yet so they only had to stop a couple of times. The doctor explained what she was doing each step of the process, and my husband and then the midwife held me steady. I remember the anaesthetist saying to me “now you must not move for any reason”, as she entered the epidural space.

She gives me some great advice - if I feel pain on one side, simply lie on that side and press the button for an extra dose of anaesthetic. They add oxytocin to my drip to ensure my contractions continue, and leave us to get a bit of rest. I need to switch sides every hour or so, otherwise my thigh muscles tense up like a terrible cramp.

From midnight to 8am, I manage to get a bit of sleep, though I max out the boosting button on the epidural. I can hear our baby’s heartbeat on the monitor, and I can relax due to the constant galloping noise that fills the room. I have to keep on moving the heartbeat sensor lower down, so I know that he is progressing. I am still really scared about everything - labour, birth, looking after a baby, so I try to just focus on the moment without thinking about the future.

Just before she leaves her shift at 8am, I tell her that the contractions are feeling lower and more painful. She checks me, smiles, and gets my husband. Shows him that the head has dropped, and he gets his first glimpse at our son. He holds a mirror up so that I can also see the head, and I think to myself that maybe I can do this after all. He seems so close to the exit that I feel like he’ll be here in no time. She asks me to stop pushing on the “extra” button of the epidural so that I’m able to feel each contraction.

At 10am, I call the next midwife and tell her that the contractions are now frequent and painful, and that I think the baby is ready. She agrees, and we do a few practice pushes. She tells me to push with each contraction, holding my breath and pushing with all my strength. She then gets into position between my legs. With each contraction she yells “allez allez go go go push push push like you have to go to the bathroom”. If it’s a strong push she yells “more more like that keep on going yes yes yes”. If it’s a poor push she tells me afterwards that I have to try harder. Surprisingly, one of the most difficult aspects is that my thighs start to cramp up with each contraction, and the pain of that blocks my ability to push with any strength. I find that stretching out my legs by placing them on the midwife’s shoulder offers some temporary relief. She gives me a strange look, but I don’t care.

After an hour of pushing, they tell me that they have to call in the doctor to use a vacuum, but they will give me ten more minutes first if I feel strong enough. I try for another ten minutes, but I feel defeated, I don’t feel like the baby has moved at all, and that all my pushing is for nothing. My husband is great, telling me that I’m doing a fantastic job, but I don’t really believe him. I only feel strong enough to push with every second contraction, and I can hear the disappointment in the midwife’s voice when I fail to be strong enough.

As the midwife is French, she often pokes my belly and announces “she’s still there” when checking for my contractions. In between contractions we have a conversation about the gender of French nouns, my husband comments that it makes sense that contractions are feminine, then I tell him that the gender of “vagina” is male - le vagin. Usually I’m too shy to bring up this example, but I figure it was appropriate in this context.

Another ten minutes of pushing, he’s still not out, it’s time for the vacuum. The doctor and the paediatrician arrive, and the vacuum is prepped. The midwife steps out of the way and is replaced by the doctor and her contraption. She attaches the vacuum, and helps me with each push. I am exhausted, and I feel like giving up. I don’t feel like I’m getting anywhere. I am tired, and I don’t want to push anymore, but the doctor tells me that I don’t have a choice at this stage, I have to keep on going. Suddenly I hear my husband’s voice telling me that he can see the head, that it’s coming out, and I get a new sense of energy. Only my husband’s voice keeps me going “I can see the head, he’s coming out, keep on going, there’s an arm, nearly there, great job sweetie”.

At 11:53 am, all of a sudden they plop this enormous purple bloody wriggling baby on my chest. I am astonished that something like that just came out of me. He had a very pointy head, though my husband tells me that by the time I saw him, it had already shrunk.

The then lifted him up to weigh him, and I watched him being checked by the paediatrician to ensure that he had not been overly harmed by the vacuum extraction. They told us that he was 4.4 kg and 54 cm. We later learn he has an APGAR score of 9 after 1 minute (white hand), and then 10 after 5 minutes. I watch as the midwife gave me an injection in my leg to encourage the delivery of the placenta and the doctor extracted cord blood for anonymous donation.

Somehow an hour past, and they told me that I had not yet delivered the placenta. They asked me to push a bit more, but that achieved nothing. The doctor told me that she would have to manually extract the placenta - reach inside my uterus and scrape it off by hand. They called an anaesthetist who injected several doses of anaesthetic straight into my epidural drip. He also told me that he likes to plan for the worst case scenario, and attached a second trip to my right arm, in addition to the drip on my left arm.

The manual extraction was by far the most painful part of the process, I don’t know how unbearable it would have been without the epidural. I called out in pain, and I was touched that the anaesthetist kept on apologising, saying he had given me the maximum dose, and he was so sorry it wasn’t working. No one ever said to me that this was childbirth, and pain was part of the process.

The doctor waited for me to get my breath, but she said it was critical that she finish the process as soon as possible. A few more minutes, and the process was complete. However, they told me that I had lost 2.5 litres of blood by then, and I needed a transfusion. My husband later told me that the bucket underneath me was filled with blood and tissue, the floor was a mess of red, and the sink was full of bloodied instruments. They ask him to sit down while holding the baby as they don’t want him to faint. Luckily he is very good with blood.

I start shaking uncontrollably, and they cover me with blankets and bring the overhead heater to beam down on me. I look up and see that I’m hooked up to four different bags of liquid on my left arm, including a bag of blood. On my left arm I have a saline drip. They ask me to take some tablets, the side effect being that my temperature will be raised. Now I am the one hooked up to a heart-rate monitor. They tell me I must stay here until I have received two bags of blood, one bag of plasma, and my heart-rate drops below 100. Everyone seems calm, though, and I am impressed by their quick response.

I am so glad that my husband was there to hold our baby, while I am laying there, my legs propped up on a block of foam. While we were waiting for all the infusions to finish, we try nursing Our baby for the first time. This was not very easy as I was laying flat on my back. Our baby made snuffling piglet noises that made us laugh, and he eventually found the nipple. The midwife squeezed my other nipple to show me that I was indeed making colostrum, which our baby seemed to enjoy.

Many hours later, at 8pm, I had stabilised and they announced I was ready to be wheeled into the maternity ward. We arrived into our room with a small single bed, no food, no bed for my husband, and down here the midwives only seem to speak French. I feel quite lost. After several requests, they finally bring a meal for me and a bed for my husband. It was the start of four unpleasant nights, with the night nurses barging in constantly and bringing criticism for whatever we were doing with Our baby at the time.

Four days later, our baby and I passed our medical tests, he started to regain weight, and we were permitted to leave the hospital. We walked through the park with him in his stroller, and arrived home, ready to start our new life with a child.

The past two weeks have been harder than I imagined. Thankfully the breastfeeding has been going very well, and I am so grateful that my husband does the majority of the work during the day, leaving me to rest and relax. Still, I am not yet feeling very attached to our baby as our interactions seem to be this three-hour cycle of feeding, changing, and soothing. He hates sleeping in his cot, which means that often during the day he rests in our arms, then spends the nights swaddled and complaining as we try to get him used to sleeping alone on his back.

I am so thankful that he is healthy and growing and thriving. I realise that I am so lucky, that there are so many people out there who would give anything to have what I have right now, but at the moment, honestly, it is not very rewarding. They say the first social smiles will start in another three weeks, to which I am desperately looking forward.

He's here

I have a sleepy little boy in my arms. Born 9.7 lbs after a vaginal vacuum extraction. Three stitches. Two liters of blood lost during manual placenta extraction. Apgar 9/10/10 - one white hand. He is exhausting work, looks a little like Churchill. Feeling accomplished. Husband marvellous during labour and also now. I have yet to change a diaper in his 48 hours of life.

40w2d

Dear Belly Bump,

Very soon you will no longer be there when I look down. I have treasured these last nine months of pregnancy. I love resting my hand on my bump and feeling the wiggles inside. I loved the chance to buy a whole new wardrobe to show you off to the world. I love the feeling of being pregnant, of growing life inside me. Though it has sometimes been disturbing to see my body change so dramatically, I feel so truly lucky to have had this experience.

I think that soon I will have a very lonely belly. But a very full heart.

40w0d: Due date

According to Franz Naegele's 1812 calculations, today is my due date. It has been 266 days since conception.

I can still feel the little guy wiggling around inside, but no painful contractions or other signs of labour.

My docgtor says that as my gestational diabetes is under control, she won't induce for another 10 days. So we still don't know if he'll be a July or August baby.

Truth be told, I'm a bit terrified of the next stage. Not so much the birth, but the whole being responsible for a new human being thing. It seems like such a huge responsibility, and I've never even held a newborn before. Now I'm supposed to be a mother? There are so many unknowns - soothing, breastfeeding, playing, nurturing...

After everything we've gone through, I really hope that I'm good at this.

New bump photos here.

39w0d: Full term

Still pregnant, no signs of labour yet. Feeling so thankful that we have made it so far with relatively few problems.

My maternity leave started today, and as I can barely walk for 5 minutes without discomfort, I am spending a great deal of time on the couch.

I have another fetal monitoring session tomorrow - 30 minutes of listening to the heartbeat and watching my painless Braxton-Hicks contractions that are coming every 10 minutes or so.

We have a big, posterior baby, so labour is not going to be short or easy. I am planning on taking as many drugs as possible to get me through.

All in all, very happy and thankful, still in disbelief that a child will be joining our family and we are soon to be parents. We both feel that it is much more likely that I will just remain pregnant forever.

36w0d: Still moving along

And here I am, one week away from being considered full term, one month away from my estimated due date.

Firstly, I'll get my complaining out of the way. I managed to stay vegan for about 24 hours before I resorted back to the deliciousness of eggs, cheese, and meat. I am still unable to resist cake, even though I know it is bad for both me and the baby in my gestational diabetic state.

My feet and ankles are terribly swollen, my belly and hips have erupted into a swarm of stretch marks, and I get a painful sharp cramp/round ligament pain sensation whenever I have to walk for more than 10 minutes. Turning over in bed is an effort, and the heat is not helping. We are still on the waiting list for all our creches, and they have yet to confirm availability for 2012.

However, apart from all that, things are pretty good. I am feeling really happy most of the time, finally starting to embrace and celebrate this pregnancy. I had a wonderful baby shower and felt very spoiled by all our friends who brought beautiful gifts for the little guy.

He seems to be doing very well - still measuring one week ahead, and my gestational diabetes doesn't seem to be affecting him too much. His head is down and the placenta has moved up, so it is likely that we will try for a vaginal birth.

I have a feeling the baby will come early as he is measuring ahead, my husband has statistics on his side when he says the baby will come late as he is our first. Either way, I can't wait to meet our son and see my husband holding him in his arms.

30w3d: Gestational diabetes

The good news is that the little guy is doing well. He is moving a lot, the placenta is moving away from my cervix, and my fundal height is on track.

The bad news is that I have gestational diabetes. I am diabetic. I rang my doctor to confirm my "no news is good news" theory, and she told me that I had failed the one hour test. Then I failed the fasting two hour test. They took another 7 vials of blood from me this morning, and I have my first meeting with an endocrinologist on Monday.

As soon as I got my diagnosis I went to the shop and bought three books on diabetes, and I have spent this morning reading the literature on randomized trials of diet and diabetes.

From the studies that I have read, it seems that the quickest way to get my diabetes under control is to follow a low-fat low-GI vegan diet. What is the evidence for this?

• After adjustment for age, sex, ethnicity, education, income, physical activity, television watching, sleep habits, alcohol use, and BMI, an observational study found that vegans (OR 0.51 [95% CI 0.40–0.66]), lacto-ovo vegetarians (0.54 [0.49–0.60]), pesco-vegetarians (0.70 [0.61–0.80]), and semi-vegetarians (0.76 [0.65–0.90]) had a lower risk of type 2 diabetes than nonvegetarians. N = 60,903 ¹
  
  
  
• A prospective cohort study (N = 3,158) and a case-control study (N = 596) found that compared to no egg consumption, adjusted relative risks for gestational diabetes were 0.94, 1.01, 1.12, 1.54, and 2.52 for consumption of ≤1, 2–3, 4–6, 7–9, and ≥10 eggs/week, respectively (P for trend = 0.008) ²
  
  
  
• A randomised trial (N = 99) found that type 2 diabetics allocated to a low-fat low-GI vegan diet (rather than the 2003 American Diabetes Association diet) had significantly lower HbA1c and cholesterol levels ³

I had always thought that the vegan diet was only suitable for self-righteous stinky hippies, but it looks like this is what my plate will look like for the next ten weeks:



1. Tonstad S, et al. Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes. Diabetes Care May 2009 vol. 32 no. 5 791-796
2. Qui, et al. Risk of Gestational Diabetes Mellitus in Relation to Maternal Egg and Cholesterol Intake. Am. J. Epidemiol. (2011) 173 (6): 649-658.
3. Bardard, ND, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment
of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009;89(suppl):1588S–96S

28w5d: Third Trimester

I have finally arrived in the third trimester, and things are still going well. I have puffy ankles and constant heartburn, and the occasional backache, but no major problems.

Last week I had my glucose test. I know that a lot of women complain about it, but for me it felt like a right of passage. It's an experience that I had read about so many times, it seemed surreal to be sitting there with all the other pregnant ladies, drinking my sugar drink and waiting the hour for my test. I haven't heard back from my doctor, so I'm figuring that no news is good news.

The little guy is wriggling all around, so reassuring to get a little poke every hour or so to let me know that he's doing okay. I love sitting on the couch with my hand on my belly, feeling him press against my skin. It is so difficult to refrain from doing so while in business meetings when I can feel him bouncing around in there.

The nursery is finished - cot, rocking bassinet, changing table. Some friends are throwing me a small baby shower next month, which is very unusual in Europe - many people consider it bad luck to give gifts before a birth. Sometimes I feel a little presumptuous too, decorating a room for a person who has yet to arrive in this world, and it's hard to believe that in less than three months we could be parents.

Ye every day his chances of survival increase if he were born prematurely, every day his kicks feel stronger, ad every day I can feel my womb expand as he grows.

Eleven weeks to go.

26w2d: All is still good

We had our first check-up at our new hospital today. It was a bit daunting moving from our IVF hospital to the one closer to home, but after today I feel a lot more confident. There didn't seem to be many differences between the two places, and I feel a lot better knowing that we are now so close to our chosen labour and delivery ward.

My fundal measurement is 27 cm, right on track. She did a quick ultra-sound - the little guy is head down, but the placenta is still a little low. If it stays low, then they will do a cesarean, but won't make that decision for another 10 weeks.

My feet are enormous, but I my urine and blood pressure are normal, so my fears of pre-eclampsia were unfounded at this stage.

Next week: glucose test and the start of the third trimester.

So thankful that everything looks good so far.

24w1d: Viability

So we have reached viability, with a theoretical 50% survival rate if the fetus was born today. Happily, he doesn't look like he's going anywhere anytime soon. I'm still feeling pretty good. I have a lot of heartburn, and I can't really bend over any more, but I am still able to sleep reasonably well.

We've even started doing some shopping. There was a special at the supermarket last week, so I bit the bullet and even bought some diapers. We have started talking about names, and looking at cribs. With every day that passes, I am feeling less terrified of disaster, and more excited about the future.

22w0d: Overwhelmed but happy

So, I think that I may finally be accepting the fact that I am pregnant. This is helped by everyone around me pointing out that fact. The guy that served my lunch on Friday said "Had a great weekend. Both of you". Neighbours are stopping me to wish me congratulations. Honestly, I'm amazed at how brave people are to comment on my bump this early on. But it is nice to know that all those extra kilos have been collecting at the right places.

The fluttering has turned into kicking, and it is so reassuring. As I have an anterior placenta, the doppler is quite difficult to use, but with all those kicks throughout the day, I usually feel pretty certain that everything is okay.

I am trying to read some baby books, but will often feel overwhelmed with how much there is to learn, and how much we have to do before the end of July. I am excited too, though. Every day I am reminded how lucky we are to be in this situation, and how if everything continues to go well, what an extraordinary summer we will have.

Scan and bump photos here.

20w0d: Anomaly scan

This morning we had our 20 week ultrasound. Before the scan, my husband was talking to me, saying that today is the day that we find out whether we're having a son or a daughter. I told him that I didn't want to think about it and made him talk about other things. However, they called us up right on time, and soon got down to business. Everything looked great, and the sonographer couldn't find a single thing for me to worry about. They counted the fingers and the toes, looked at all the internal organs, checked the placement of the placenta and the fluid, and took a bunch of measurements. The baby weighs 377 grams, and we found out today that I am carrying a boy. It is strangely wonderful to be able to say "he" rather than "it". My husband has told me that I now have to start facing up to the fact that we are most probably going to have a son in less than 5 months.

18w6d: Babymoon

We are having a wonderful time on our babymoon. It is so luxurious to get away from the daily stresses of life, and just kick back and relax. I am loving our two weeks by the sea, soaking in the sunshine and spending long hours with my husband. I now feel the little one wiggling away every day, which is so reassuring and delightful. We are both feeling very hopeful for the future, and I love the way that my husband rubs my belly when we sit side-by-side.

Now only over a week until our 20 week scan. If we can, I would like to find out the sex, but most of all I am hoping for a perfect bill of health for this little one.

17w6d: Quickening

On 10:30am on Valentines Day, I was sitting in front of my computer focusing on a Word document, when I felt a tiny little *something* in my lower belly. At first I didn't pay it much attention, and then, when I realised what it could be, the rest of the world suddenly disappeared.

All I could focus on was these soft little flutters above my pubic bone. Flutters the like of which I had never felt before. This was the day I first felt our little one move inside me. Now, about twice a day, after I have been sitting quietly for an hour or so, I feel these little wiggles and tickles and pokes that are delightful and charming.

Each day, it is starting to feel more real.

Now, we are off for a two-week babymoon to pass the time until our 20 week scan. Fourteen quiet days near the sea (and a world class hospital) to celebrate what will hopefully be our last vacation as a family of two.

16w1d: Up to speed

I had a great check-up yesterday. The doctor kindly explained that they couldn't do a routine 16 week ultrasound for everyone, but she would do a uterus palpatation, fundal height measurement, and a doppler check. If any of those looked off, then she would send me for a scan.

She said that she could feel my uterus sitting just underneath my belly button, and showed me how to feel it myself. My fundal height was 14 cm (at 16 weeks it should be 16cm +/- 2cm). She had a great deal of difficulty finding the heartbeat, which made me feel better about having trouble with my home doppler. She found the soft wooshing of the ubilical cord pulse quite easily, and some sporadic sloshes of the fetus moving, and finally about 20 seconds of the loud galloping fetal heartbeat at 160 bpm, before the fetus swam away again.

I know that we didn't get an ultrasound, but all in all I felt very reassured. The doctor seemed so calm and confident that I felt like any other pregnant woman in for a routine check-up.

And now only four weeks to go until we reach the half-way point and our big 20 week morphology scan.

15w6d: Check-up tomorrow

Since the 12 week scan, my emotions have varied from relief to happiness to fear to worry. Relief that nothing bad was detected, happy that I graduated from the first trimester, fear that bad things will happen, and worry that the heartbeat was in the bottom 1% for gestational age.

I now have a noticeable bump (latest photo here), and my pregnancy was publicly announced during the last departmental meeting. Most of our friends in this city have not experienced fertility or loss, however they seem understanding of my "let's wait and see" attitude. A few of them have said to me "can I be excited for you, on your behalf?", which is sweet.

While I have heartburn, round ligament pain, a runny nose, frequent urination, headaches, and breathlessness, there is nothing unbearable. I am surprised every time I see myself in the mirror.

I individually emailed the people in my IVF support group to tell them my news, starting with "I know that it can be difficult to hear this...". Some of them have replied with congratulations, others have remained silent, which I understand perfectly.

My next check-up is tomorrow. They told me that they will do a Doppler heartbeat check, but no ultrasound. I would really love a reassuring glimpse to know that the fetus is measuring properly. Does anyone know of any secret phrases that will convince them to do an ultrasound, without having to lie about my symptoms?

14w3d: Out

My belly and the word are both out. I have told my close friends, family, and my boss. I have booked childcare. Random colleagues are coming up to me to wish me congratulations. Presents are starting to appear in the mail.

Apart from the few moments of terror and fear, I am mostly starting to feel a little bit excited. Cautiously optimistic, sometimes. I am now officially in my second trimester.

Frustratingly, I am still having trouble finding a consistent heartbeat with my cheap eBay doppler. I am trying not to worry too much, as even the tech couldn't get a good abdominal scan at my last ultrasound with her fancy-pants machine. I have my next check-up in 11 days.

Finally, I will not be able to make it to my next IVF support group dinner. I have not yet told any of the ladies my news, as I do not see any of them outside these events. Should I send an email? Should it be individual or reply-all? What should it say?

The NT scan

This Tuesday last week I was anxiously counting down the hours until my NT test. I was a bundle of nerves, and had to break down the activity into tiny steps so that I could get through it (get dressed, leave house, get to hospital, walk through front doors, etc). My doppler still hasn’t arrived, so I had no idea if the foetus was even alive.

I arrived 30 minutes early and impatiently waited for my husband to arrive, as he left it to the last minute and only arrived 5 minutes early. Twenty minutes after that, they called us in. My first transabdominal ultrasound, I didn’t even have to take off my pants.

The technician pressed down on my belly and a grainy picture appeared. At first glance, it didn’t look that different from the scan three weeks ago, and my heart froze. But she pointed out the heartbeat and I started to relax. I thought that I had been a responsible patient by drinking a litre of water an hour beforehand, but the technician said that all I was doing was forcing my uterus further towards my spine. She sent me to the bathroom to empty my bladder, and then got down to business.

Everything looked great. The foetus was measuring 6.5 cm (12w6d) at 12w0d with a femur length of 0.68 cm and a NT thickness of 1.49mm (photo of the fetus with a hand on its nose here). I was so relieved when I saw that NT measurement. Then the technician went on to check all the organs, pointing them out as she went along: brain, stomach, kidneys, spine, fingers, feet, even the four chambers of the heart. Due to the position of my uterus, she switched to a transvaginal probe for some of the measurements, so I got a visit from my old friend too. All in all, she concluded “it is a good baby”.

The foetus waved its hands in front of its head, occasionally wiggling and kicking. Although the print outs were a bit poor, seeing the live-action movement on the screen was incredible. With my husband by my side, holding my hand and smiling at me, we could have watched that little thing for hours.

After she had finished, the supervising doctor came in to double-check the measurements. I was a little concerned that the heart rate was a little low (151 bpm) – (the mean rate is 159 +/- 3 bpm at 13 weeks). She did something where she did four different types of doppler heartbeat measurements and said that everything looked fine.

My urine, weight, and blood pressure looked good, so they printed out an official certificate of pregnancy that I need for my work and for securing a childcare position. A few days later I heard that my combined trisomy risk is 1:11 600 for T13 and 1:20 000 for the others.

So, there we are. So far, things look good. Now another three weeks until my next check-up, and another seven weeks until the big anomaly scan.

12w0d

Everything looks great. We have a wriggling 6.5 cm fetus with a 1.5 mm NT measurement. Arms, legs, brain, heart, etc all look good Details and pictures to follow.

11w3d: Exhausted

In exactly four days time I will be making my way to the hospital for my NT scan. I am scared of all the things that can go wrong, and excited about what a milestone it will be if everything looks good.

So in order to get me into the spirit of the occasion, I have been doing what any good scientist would do, and reading through the literature surrounding the tests that will be conducted at this appointment, mainly, the NT scan and the blood tests.

The nuchal translucency (NT) test measures the thickness of the sack of fluid behind the neck of the fetus. In general, a fetus with a trisomy (three copies of a chromosome, rather than two) has a thicker NT than a chromosomally normal fetus.

The first figure below illustrates this observation. Each black dot represents two measurements (the crown-rump length and the NT thickness) of a single fetus that was subsequently found to have trisomy 21 (Down's Syndrome). The dark grey rainbow is the distribution of 90% of chromosomally normal fetuses. As you can see, in normal fetuses the NT thickness gradually gets thicker as the fetus gets larger. However, in trisomy 21 fetuses, the thickness remains relatively constant during this gestational period, with a mean thickness of 3.4 mm.

(from Kagan, et al., Ultrasound Obstet Gynecol 2008; 31: 618-624)

The second test is a blood test of the mother to measure our old friend beta-human chorionic gonadotropin (beta-hCG) as well as pregnancy-associated plasma protein-A (PAPP-A). The values on the axis are multiples of the median (MoM), that is, by how many-fold does a result differ from the median value from all normal women. By definition, the median beta-hCG for unaffected pregnancies is 1.0, and the median PAPP-A for unaffected pregnancies is also 1.0.

This second figure below shows how the blood tests from women with trisomy 21 fetuses varies from women with chromasomally normal fetuses. Each dot represents the values from a single patient with a trisomy 21 fetus. The unfilled oval represents the lab values of 90% of women with chromasomally normal fetuses. The median beta-hCG values were 2-fold higher and the the PAPP-A values were 2-fold lower in women with trisomy 21 fetuses.

(from Kagan, et. al., 2008, Ultrasound Obstet Gynecol, 31: 618-624)

So here's hoping that all my dots fall in the normal range, and I can pass this test and start to look forward to moving into the second trimester. It is still feeling unreal, so I hope that seeing a wiggling little fetus on the ultrasound next Tuesday will put some of my anxiety to rest.

References:

Kagan, K.O., Wright, D., Baker, A., Sahota., D., & Nicolaides, K.H. 2008. Screening for trisomy 21 by maternal age, fetal nuchal translucency thickness, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol., 31: 618-624